1. Down’s Syndrome and Infection u Known high mortality (1960-71) –Respiratory diseasesx62 –Infectious diseasesx12 –Cardiac diseasesx6 –Malignanciesx?

2. Down’s Syndrome and Infection u Predisposition to Infection –Structural »Cardiac disease »ENT anatomy –Immunological »Primary »Secondary

3. Down’s Syndrome and Infection u Predisposition to Infection –Primary »Cellular »Humoral –Secondary »Diabetes »Coeliac disease

4. Down’s Syndrome and Infection u Evidence for immune dysfunction  Rate of infections  Production of antibodies after immunisation (variable)  Cellular function (variable)

5. Down’s Syndrome and Immunisation - 1 u All routine u Influenza u Pneumococcal u ?Hepatitis B u Special consideration when abroad

6. Down’s Syndrome and Immunisation - 2 u So many unknowns therefore u ?multicentre trial –usual immunisations –pneumococcal –influenza –?hepatitis B »monitor immunological responses »monitor infection rates